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General NPI Number Information
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NPI Number | 1548949142
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Entity Type | Organization
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Legal Business Name | MONADNOCK PERIO & IMPLANT CENTER
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 819 COURT ST UNIT A
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City | KEENE
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State | NH
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Zip | 03431-1773
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Country | US
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Telephone | 603-215-5800
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Fax | 603-499-7011
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Provider Business Mailing Address
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Address Line | 819 COURT ST UNIT A
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City | KEENE
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State | NH
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Zip | 03431-1773
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Country | US
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Telephone | 603-215-5800
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Fax | 603-499-7011
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. LORI RECTOR
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Credential |
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Telephone | 603-215-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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